Trends in Labor Unionization Among US Health Care Workers, 2009-2021.

Importance: Labor unionization efforts have resurged in the US, and union membership has been shown to improve worker conditions in some industries. However, little is known about labor unionization membership and its economic effects across the health care workforce. Objectives: To examine the prevalence of labor unionization among health care workers and its associations with pay, noncash benefits, and work hours. Design, Setting, and Participants: This cross-sectional study was conducted using data from the Current Population Survey and Annual Social and Economic Supplement from 2009 through 2021. The US nationally representative, population-based household survey allowed for a sample of 14 298 self-identified health care workers (physicians and dentists, advanced practitioners, nurses, therapists, and technicians and support staff). Exposures: Self-reported membership status or coverage in a labor union. Main Outcomes and Measures: Prevalence and trend in labor unionization. Further comparisons included mean weekly pay, noncash benefits (pension or other retirement benefits; employer-sponsored, full premium-covered health insurance; and employer's contribution to the worker's health insurance plan), and work hours. Results: The 14 298 respondents (81.5% women; 7.1% Asian, 12.0% Black, 8.5% Hispanic, 70.4% White individuals; mean [SD] age, 41.6 [13.4] years) included 1072 physicians and dentists, 981 advanced practitioners, 4931 nurses, 964 therapists, and 6350 technicians and support staff. After weighting, 13.2% (95% CI, 12.5% to 13.8%) of respondents reported union membership or coverage, with no significant trend from 2009 through 2021 (P = .75). Among health care workers, those who were members of a racial or ethnic minority group (Asian, Black, or Hispanic individuals compared with White individuals) and those living in metropolitan areas were more likely to report being labor unionized. Reported unionization was associated with significantly higher reported weekly earnings ($1165 vs $1042; mean difference, $123 [95% CI, $88 to $157]; P < .001) and higher likelihood of having a pension or other retirement benefits at work (57.9% vs 43.4%; risk ratio [RR], 1.33 [95% CI, 1.26 to 1.41]; P < .001) and having employer-sponsored, full premium-covered health insurance (22.2% vs 16.5%; RR, 1.35 [95% CI, 1.17 to 1.53]; P < .001). Union members reported more work hours (37.4 vs 36.3; mean differences, 1.11 [95% CI, 0.46 to 1.75]; P < .001) per week. White workers reported mean weekly earnings that were significantly more than members of racial and ethnic minority groups among nonunionized workers ($1066 vs $1001; mean difference, $65 [95% CI, $40 to $91]; P < .001), but there was no significant difference between the 2 groups among unionized workers ($1157 vs $1170; mean difference, -$13 [95% CI, -$78 to $52]; P = .70). Conclusions and Relevance: From 2009 through 2021, labor unionization among US health care workers remained low. Reported union membership or coverage was significantly associated with higher weekly earnings and better noncash benefits but greater number of weekly work hours.

Mortality Rates From COVID-19 Are Lower In Unionized Nursing Homes.

More than 40 percent of all reported coronavirus disease 2019 (COVID-19) deaths in the United States have occurred in nursing homes. As a result, health care workers' access to personal protective equipment (PPE) and infection control policies in nursing homes have received increased attention. However, it is not known whether the presence of health care worker unions in nursing homes is associated with COVID-19 mortality rates. Therefore, we used cross-sectional regression analysis to examine the association between the presence of health care worker unions and COVID-19 mortality rates in 355 nursing homes in New York State. Health care worker unions were associated with a 1.29-percentage-point reduction in mortality, which represents a 30 percent relative decrease in the COVID-19 mortality rate compared with facilities without these unions. Unions were also associated with greater access to PPE, one mechanism that may link unions to lower COVID-19 mortality rates.

Organized Labor and Depression in Europe: Making Power Explicit in the Political Economy of Health.

Despite engagement with the construct of power relations, research on the political economy of health has largely overlooked organized labor as a determinant of well-being. Grounded in the theory of power resources, our study aims to fill this gap by investigating the link between country-level union density and mental health while accounting for the compositional effects of individual-level union membership. We use three waves of the European Social Survey (N = 52,737) and a variation on traditional random-effects models to estimate both the contextual and change effects of labor unions on depressive symptoms. We find that country-level union density is associated with fewer depressive symptoms and that this is true irrespective of union membership. We discuss our findings vis-à-vis the literatures on the political economy of health, power resources, and fundamental causes of disease.

Estimation of the number of working population at high-risk of COVID-19 infection in Korea.

OBJECTIVES: We aimed to identify occupational groups at high-risk of coronavirus disease 2019 (COVID-19) infection in Korea, to estimate the number of such workers, and to examine the prevalence of protective resources by employment status. METHODS: Based on the sixth Standard Occupational Classification codes, 2015 census data were linked with data from the fifth Korean Working Conditions Survey, which measured how frequently workers directly come into contact with people other than fellow employees in the workplace. RESULTS: A total of 30 occupational groups, including 7 occupations from the healthcare and welfare sectors and 23 from other sectors, were classified as high-risk occupational groups involving frequent contact with people other than fellow employees in the workplace (more than half of the working hours). Approximately 1.4 million (women, 79.1%) and 10.7 million workers (46.3%) are employed in high-risk occupations. Occupations with a larger proportion of women are more likely to be at a high-risk of infection and are paid less. For wage-earners in high-risk occupations, protective resources to deal with COVID-19 (e.g., trade unions and health and safety committees) are less prevalent among temporary or daily workers than among those with permanent employment. CONCLUSIONS: Given the large number of Koreans employed in high-risk occupations and inequalities within the working population, the workplace needs to be the key locus for governmental actions to control COVID-19, and special consideration for vulnerable workers is warranted.

Solidarity and disparity: Declining labor union density and changing racial and educational mortality inequities in the United States.

BACKGROUND: Recently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor-union density-the percent of workers who are unionized-has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities. METHODS: From CDC, we obtained state-level all-cause and overdose/suicide mortality overall and by gender, gender-race, and gender-education from 1986-2016. State-level union density and demographic and economic confounders came from the Current Population Survey. State-level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure-outcome relationship, we used marginal structural modeling. Using state-level inverse-probability-of-treatment-weighted Poisson models with state and year fixed effects, we estimated 3-year moving average union density's effects on the following year's mortality rates. Then, we tested for gender, gender-race, and gender-education effect-modification. Finally, we estimated how racial and educational all-cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively. RESULTS: Overall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval [CI]: 0.70, 0.98), or 5.7 lives saved per 100 000 person-years (95% CI: -10.7, -0.7). Union density's absolute (lives-saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all-cause mortality overall or across subgroups, and modeling suggested union-density increases would not affect mortality inequities. CONCLUSIONS: Declining union density (as operationalized in this study) may not explain all-cause mortality inequities, although increases in union density may reduce overdose/suicide mortality.

Building a Sustainable Construction Workforce.

The average U.S. construction worker is aged 42.6 years, and will not be eligible for full Social Security retirement benefits until age 67. Delayed retirement is largely driven by economic need, but construction workers face considerable challenges in remaining on the job. This study explores trade-specific age trends within the construction industry, and the experiences of building trade unions with aging membership. A mixed-methods approach used trade-specific age statistics from the Current Population Survey and key informant interviews with labor leaders, in order to identify union experiences and interventions. Mean and median ages for all subgroups in construction increased from 2003 to 2017. Immigrant construction workers were significantly younger than workers who were born in the U.S. (41 vs. 43, p < 0.001). Union workers were older than non-union workers (42 vs. 39 in 2017, p < 0.001); the age differential between self-employed and wage-and-salary workers was wide (49 vs. 40, p < 0.001). Union leaders described barriers, such as age discrimination and the loss of previously available light tasks, as well as current and potential solutions through union contract language requiring the inclusion of older workers, or establishing limits for lifting. Other solutions included career pathways for training and safety, with their attendant limitations; mentoring/pairing opportunities with apprentices; and the potential opportunities and training needs for site management positions.

Menopause and work: an overview of UK guidance.

BACKGROUND: Recent evidence suggests that some women experience menopausal symptoms that impact on their working lives, and that work environments can impact upon the experience of menopause. As a result, guidance for employers and other key stakeholders about this potential occupational health issue has emerged. To date there has not been a review of these documents to identify their main recommendations for policy and practice. AIMS: To provide a narrative overview of such guidance and summary of content. METHODS: Documents published in the UK and available in a major UK trade union library were searched systematically to identify guidance on the topic of menopause and work. An inductive thematic analysis was performed to identify the main themes addressed. RESULTS: Twenty-five relevant documents, on average eight pages long, were identified. A minority indicated that the use of scientific evidence informed the content. Five overarching themes were identified: (i) legislation; (ii) policy; (iii) information and training needs; (iv) workplace support; and (v) the physical work environment. CONCLUSIONS: This overview of UK guidance revealed common areas of concern about reducing and managing difficulties experienced by working menopausal women. Possible areas for action were identified. Some recommendations were common across much of the guidance, whereas others were exclusive. Future guidance might include consideration of all these issues, while making reference both to the evidence base and sources of further information.

Compensation Appraisals and Labor Union Membership.

Given the beneficial effects of labor unions on "bread and butter issues," union members should appraise their economic circumstances more favorably than nonunion members do. Yet, research on the anomaly of the dissatisfied union worker challenges this expectation. Using the General Social Survey's Quality of Work Life module, this article examines whether union members appraise their economic circumstances less favorably than nonunion members. Results suggest that union membership is associated with more favorable appraisal of benefits but not wages. These findings may help to provide at least a partial explanation for the anomaly of the dissatisfied union worker. Because income constitutes a vital component of job satisfaction, this study contributes more broadly to our understanding of employee well-being. It also connects the study of occupational health to that on institutions, contributes to the growing literature on the political economy of health, and highlights latent effects of union security agreements.

Work-related injuries and fatalities in the geotechnical site works.

Geotechnical site works are comprehensive, and they constitute the first step of the construction process. This study performs data mining of geotechnical works and analyzes the database for the root causes of accidents. The Occupational Safety and Health Administration (OSHA) was chosen for the 1984-2013 time frame with 247 cases. Descriptive statistical analyses were performed to discuss variables such as the end use of the work, project type and cost, soil type and condition, type and degree of injury, cause and type of accident, unsafe acts, and occupation and union status of the victim. The results showed that these accidents have a high frequency of recurrence and have a high severity level (54.3% fatalities). In addition, a total of 838 violations were recorded with penalties reaching 5 million US dollars. This study emphasizes that project-specific countermeasures should be taken regarding the root causes of accidents, leading to vigorous strategies to develop safety measures.

Risk of Injury by Unionization: Survival Analysis of a Large Industrial Cohort.

OBJECTIVE: To investigate the effect of union status on injury risk among a large industrial cohort. METHODS: The cohort included hourly employees at 19 US plants between 2000 and 2007. Plants were classified by union status, and injuries were classified by severity. Cox-proportional hazard shared frailty model was used to determine time to first reportable injury. RESULTS: A total of 26,462 workers were included: 18,955 (72%) unionized and 7507 (28%) non-unionized. Union workers incurred 3194 injuries (16.9%) compared with 618 injuries for non-union workers (8.2%). After adjusting for multiple covariates, union workers had a 51% higher risk of reportable injury. CONCLUSIONS: Our results provide evidence for higher risk of reportable injuries in union workers; explanations for this increased risk remain unclear.

"Contract to Volunteer": South African Community Health Worker Mobilization for Better Labor Protection.

In this paper, we explore the increasing activity around labor rights for South African community health workers (CHWs). Contextualizing this activity within broader policy and legal developments, we track the emergence of sporadic mobilizations for decent work (supported by local health activist organizations) and subsequently, the formation of a CHW union. The National Union of Care Workers of South Africa (NUCWOSA) was inaugurated in 2016, hoping to secure formal and secure employment through government and the consequent labor and occupational health protections. Various tensions were observed during fieldwork in the run up to NUCWOSA's formation and raise important questions about representation, legitimacy, and hierarchies of power. We close by offering suggestions for future research in this developing space.

Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis.

As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.

Perceived discrimination and low back pain among 28,532 workers in South Korea: Effect modification by labor union status.

OBJECTIVES: This study investigated the association between workplace discrimination and low back pain among Korean workers and explored the role of labor union in the association. METHODS: We analyzed a cross-sectional survey of 28,532 workers from the 3rd Korean Working Conditions Survey (2011), a nationally representative dataset in South Korea. Experience of workplace discrimination for five different reasons was assessed using the questions: "Over the past 12 months, have you ever experienced workplace discrimination based on your: (a) age, (b) education, (c) birth region, (d) sex, and (e) employment status?" Experience of low back pain within a 12 month period was measured using a yes/no question. Labor union membership was coded into three categories: (1) workers at workplaces without a labor union; (2) workers without union membership at workplaces with a labor union; (3) workers with union membership. RESULTS: In workplaces without a labor union, low back pain was statistically significantly associated with workplace discrimination based on age (OR: 2.02, 95% CI: 1.73, 2.35), education (OR: 1.45, 95% CI: 1.23, 1.71), birth region (OR: 1.42, 95% CI: 1.10, 1.84), sex (OR: 2.22, 95% CI: 1.81, 2.73), and employment status (OR: 2.33, 95% CI: 1.99, 2.72) after adjusting for covariates including physical work factors. However, no significant association was observed among workers at workplaces with a labor union regardless of workers' union membership. CONCLUSIONS: Workplace discrimination was associated with low back pain only in workplaces without a labor union. Presence of labor union at workplaces may have a protective effect on workers' low back pain against workplace discrimination.

Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in U.S. Hospitals: An Econometric Regression Decomposition.

OBJECTIVE: To detect the presence of racial and ethnic pay disparities between minority and white hospital RNs using a national sample. DATA SOURCES/STUDY SETTING: The National Sample Survey of Registered Nurses, 2008, which is representative at both the state and national level. STUDY DESIGN: Cross-sectional data were analyzed using multivariate regression and regression decomposition. Differences between groups were decomposed into differences in the possession of characteristics and differences in the value of the same characteristic between different groups, the latter being a commonly used measure of wage discrimination. DATA COLLECTION/EXTRACTION METHODS: As the majority of minority hospital RNs are employed within the most densely populated (central) counties of metropolitan statistical areas (MSAs), only hospital RNs employed in the central counties of MSAs were selected. PRINCIPAL FINDINGS: Regression decomposition found that black and Hispanic RNs earned less than whites and Asians, while Asian RNs earned more than white RNs. The majority of pay variation between white RNs, versus Asian, black, or Hispanic RNs was due to unexplained differences in the value of the same characteristic between groups. CONCLUSIONS: Differences in earnings between underrepresented and overrepresented hospital RNs is suggestive of discrimination.

Union Density and Hospital Outcomes.

The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income.

The Prevalence and Distribution of Aging-Friendly Human Resource Practices.

The aging of the workforce in the developed world has prompted organizations to implement human resource (HR) policies and practices encouraging older workers to defer retirement. However, little is known about the prevalence of such practices, and the organizational factors associated with their adoption. In this study, we used data collected from 2008 to 2009 from a national probability sample of retirement eligible workers in the United States (N = 407) to assess the prevalence of aging-friendly human resource practices (AFHRP), and their organizational predictors. Results indicate that employee wellness programs, unpaid leave, and reassignment based on physical needs are among the most prevalent AFHRP. However, in the vast majority of enterprises, AFHRP are limited. Results also indicate that projected organizational growth and a focus on internal labor market practices are positively associated with the adoption of AFHRP. Organizational size and the degree of unionization, while positively associated with aging-friendly benefits, were inversely associated with flexibility practices.

Protecting Construction Worker Health and Safety in Ontario, Canada: Identifying a Union Safety Effect.

OBJECTIVES: Do Ontario unionized construction firms have lower workers' compensation claims rates compared with nonunion firms? METHODS: Building trade and construction trade association lists of union contractors were linked to Workplace Safety and Insurance Board claims data for 2006 to 2012. Data were pooled for 2006 to 2012, and negative binomial regressions conducted with adjustment to estimate a union safety effect. RESULTS: The sample included 5797 unionized and 38,626 nonunion construction firms. Total claims rates were 13% higher (1.13, 1.09 to 1.18) in unionized firms because of higher allowed no-lost-time claim rates (1.28, 1.23 to 1.34), whereas the lost-time claims rate was 14% lower (0.86, 0.82 to 0.91). CONCLUSIONS: Unionized construction firms compared with nonunion firms have higher no-lost-time and lower lost-time claims rates. Unionized firms may encourage occupational injury reporting and reduce risks through training and hazard identification and control strategies.